Speaker 1: Hello, and thank you for attending our presentation entitled Best Practices, Professional Standards, and Best Practices for Telemedicine. This webinar is designed for providers who want to set professional standards and best practices for telemedicine in their practice. I'm your presenter, Al Nardi, Vice President of Strategic Initiatives at MTBC. Video and audio works best through the web. If your video or audio is not working properly, the recorded presentation will be posted online after the webinar is completed. Please hold any questions until the presentation is completed. As is true in almost everything in business as well as in life, it is important to set your goals first. What do you want to achieve? Why do you want to achieve those goals? What do you consider success, and what does a plan be if you cannot achieve complete success? How can you achieve the goals, including technology and non-technology solutions? When? What is your timeline to achieve your goals? It is important to define what success means to your practice. Spell out the metrics and measurements so that you, your partners, and your staff know what needs to be done in order to achieve that success. Every practice is different. Your definitions might include serving more patients who are challenged by distance or those who need assistance getting to an office visit. It might also include operational improvements, such as reducing wasted travel time between offices by your medical staff or providing coverage when travel is unfeasible. But the goals you set are a unique roadmap when your own specific practice. How are you going to measure your results against your goals? Are you using data and statistics and or subjective feedback, or a blend of both? How are you gathering and reporting each? Are you setting goals that match your practice? What are your non-technology goals? Improving clinical outcomes, saving time, increasing reimbursable billing, outreach to more patients, convenience to your patient census, all have merit. What are you looking to achieve? While improving clinical outcomes has become a bit of a buzzword, it is supported by results-based increases in reimbursement. Does your EHR support the MIPS and macro reporting you need to implement increased reimbursement? Make certain that your telemedicine choice supports the same goals you want to achieve. The medical profession and clinical standards organizations like NIH set standards for overall practice processes as well as each and every medical procedure, and telemedicine is no different. Your specific protocols should match your particular practice and support your goals. What works for an internist may not work for an orthopedist, a psychologist, or a podiatrist. Even within each practice, there are other considerations pertaining to illness and injury type or patient competence and other at-risk patient conditions that should be considered. Some general practices may decide to use telemedicine only for follow-ups, but not for initial visits, especially if drugs must be prescribed. Some decide what type of patients they offer the telemedicine to, based on the patient condition, illness or ability, capability, maybe based on age, mental capacity. While average telemedicine encounter is more time efficient than average in-office, face-to-face, there are some procedures that are better handled in person. If there are any indications that a patient should be seen in person, direct them to the closest medical facility that can effectively treat that need, i.e., urgent care hospital, alternate covering physician, clinic, etc. Err on the side of patient safety, not on saving time or convenience. Patients should always be aware of their responsibility to keep their communication secure. They should be trained to have their telemedicine encounter in a private, quiet location with good internet so that they are not shouting to be heard and not easily observed or heard by others. Their part of the communication is just as important as yours, or you will not understand what the patient is saying. If you have poor phone habits with them in communication, they will have poor telemedicine encounter habits. Some have said that particular patients, certain psychological conditions or addiction treatment, that they use telemedicine but in a different workflow than we originally expected. One psychiatric practice has two locations at one-and-a-half hours' drive distance from each other. The lead psychiatrist had a set-up telemedicine patient session through calls after specific at-risk patients who live near the remote location are scheduled to come in to the remote office. Patients are ushered by a nurse assistant to a quiet meeting room where the laptop is already set up. The nurse assistant and doctor establish the call session, then the nurse assistant leaves the patient in the room where the live telemedicine session is running. The doctor and patient have their encounter. When done, the nurse assistant shuts down and sets up for the next telemedicine patient. This saves the doctor the drive time he was previously wasting going back and forth for remote visits, but it also allows the at-risk patients to have nurse assistant greet and assess them in person, which is lower cost, and have partially monitored encounter in the remote office. This could be extrapolated to serving remote underserved patients in rural areas and rural clinics. The patients don't need to have a laptop or a smartphone because it would be set up on a remote clinic. It covers rural areas where patients may be poor or don't have their own phones or internet. Age is not a good guide of technical competence either. Technology can baffle the young and the elderly, but a similar twist in the workflow serves patients with Alzheimer's and dementia or other forms of conditions where the patient may have support locally but can't operate telemedicine technology themselves without support setting up the call. Some practices serve extremely rural and impoverished patients. While those patients typically won't have their own internet access or access to modern iOS and Android phones, they're often within proximity of a clinic that can be served by the previously described workflow. An area clinic or traveling nurse practitioner with cellular service and a tablet can establish a telemedicine session with the physician remotely to consult the patient. If you are thinking about a technology solution like telemedicine, it's important to include more technology-savvy staff and hire consultants to help with the selection and implementation phases of that technology. Select a vendor who provides good integration, training, and support and consider them part of your implementation team. Include the team in the decisions and implementation. Consider including patients in feedback loop to assure that your needs are being addressed and get their subjective feedback about the new solution. As we discussed in a prior webinar, selection and implementation of telemedicine into your practice takes planning and careful execution in order to achieve success. Include your team in the feedback loop when selecting your solution. If it's a technology solution, make certain that you also select the appropriate infrastructure to support your solution. Select a telemedicine solution that will work and enhance your medical documentation workflow and works inside of your EMR, not one that operates outside of your workflow so you have additional work to support multiple standalone systems to make it function. Select a system that automates or supports your medical processes. Automation of transcription, notes, voice-to-text, or automatic submission of billing for encounters are good examples. Interactive live video telemedicine requires good quality internet to have TV-like video with no or few issues, pixelation, or out-of-sync sound or video. It is worthwhile to do an IT infrastructure audit. Have an expert assure that you have internet, computer equipment, and internal infrastructure up to the standards to deliver exceptional quality video, calls, as well as audio for telemedicine. Make certain that your telemedicine vendor provides and includes support for the telemedicine help desk type issues, troubleshooting problem resolution, online or phone support. It is extremely important to train, then test, make adjustments, test, and train again. That is, repetition and iterative learning helps to get smoother with the process and the technology. Figure out how the workflow does and does not work with your practice. Don't be afraid to adjust the way you do things or to adjust how the technology works as part of the flow of doing business. Make certain that you test on associates and staff and have them do the same thing. Have several brief roundtable discussions with staff to share what you learn, what things are not working and what you cannot figure out, and any shortcuts or ways that others suggest to use the technology. Be open to new ideas. Don't shut down any innovation or a different workflow. It may be better than what you were doing or may just be an alternative way of doing the same thing. Call on your vendor or consult for help, training, or getting set up, or education. Remember, most people are resistant to change, so don't be surprised if your associates or staff are resistant to adopting new technology. The same thing with patients. They may resist or feel uncomfortable using technology, so practice with people or have them run through online one-to-one trainings themselves. Remember that to succeed, you need to buy in at all levels, physicians, nurses, staff, and patients. Look for a telemedicine platform that offers marketing materials as part of the overall solution and deployment process. Tell all the stakeholders, physicians, nurses, other staff, patients, and even consulting physicians that you have a new solution and invite them to learn about it and use it. Patient adoption or lack thereof is one of the largest roadblock issues to address. Let people know what their benefits are for using the solution. Use waiting room posters, in-office printed patient flyers, and or email messaging to invite your own patients to get a patient portal or app to use telemedicine solution. If the patients don't have good experience, they will not want to use the solution and it will not be successful. Have a support team or an online alternative in place if a patient or fellow staff member is having issues registering or learning how to use the solution. Call in your vendor to support the training and troubleshooting process. Patient adoption and engagement are key issues that can make the difference between a good implementation or bad implementation of telemedicine in the individual practice. Proactive providers recognize that they have to encourage and show their patients that telemedicine is available to them or they won't be able to set up those telemedicine appointments. Proactive vendors support those efforts by providing standard and customized marketing flyers for patients and support other marketing advertising activities that those practices want to do. According to the HIPAA guidelines on telemedicine, any system of communicating ePHI at distance must have mechanisms in place so communications can be monitored and remotely deleted if necessary. HIPAA and other issues surrounding security are important for obvious and some not so obvious reasons. You may know your solution is HIPAA compliant, but your patients may not know unless you tell them. With all the negative publicity surrounding recent breaches in personal information, patients and other staff members want the assurance that the solution they are using is secure. Make sure it is, and then share that knowledge so everyone else knows as well. Remember telemedicine is not a phone call, it's a doctor-to-patient consultation. Treat it the same way. Respect the privacy issues and assure your patients that the private information will be kept private. If the telemedicine solution stores any data, video, voice, or text, is that contained within your EMR or outside of it, and outside of it, is that also HIPAA secure? Include formal and or informal surveys for your associates, staff, and patients. Ask if the telemedicine solution works for them, why or why not? Ask if they had issues setting up, logging in, using the solution, etc. Ask if they liked using it. For staff and associates, ask if it enabled medical documentation, coding, and billing for the encounters or not. If so, why so? If not, why not? Share that feedback with your vendor. If there are issues with the registration, ramp-up training, functionality, or features, tell the vendor what you want. Ask what they will do to smooth out any friction in making the solution fit into the practice and provide more value. Measure your results against your original goals. Okay, to review our key takeaways for telemedicine best practices. Set the goals for your telemedicine project and define what success means. Establish protocols as you would for any other part of your practice. Design workflows for your different classifications of patients. Don't forget to include at-risk and compromised patients. Select the team that will enable and facilitate your implementation and empower them to help you. Choose the solution or solutions that fit your needs. Engage your team in the selection process. Implement with support of your team and your vendor or consultants. Train associates, staff, and patients. Adjust to fit your needs. Socialize the solution with associates, staff, and patients. Continue to engage and promote to patients and build adoption. Get feedback and measure your solution against your goals. Share the feedback with your team and your vendor. Thank you for attending our webinar. Any questions will be addressed individually after the webinar. Contact us if you have additional questions. For more information, go to www.talkmd.com.